More dental patients seeking care in Lubbock emergency rooms

ER not good for dental care

More Americans are turning to hospital emergency centers for routine dental care, and Lubbock is no exception.

Preventable dental conditions were the primary reason for 830,590 emergency room visits by Americans in 2009 — a 16 percent increase from 2006, according to a February report by the Pew Center on the States.

Tavia Hatfield, director of community outreach at Covenant Health System, said emergency room doctors at Covenant say they’re seeing patients come in for dental care every day. A majority have toothaches related to an abscess or a tooth that needs to be extracted, she said. Some of the cases are accident related, but most are untreated, long-term dental problems.

“I think they go to the emergency room because they’re uninsured, they’re in pain, and they don’t have anywhere else to go,” Hatfield said. “Even though the emergency room does not have dentists on staff, at least they can get pain medication and antibiotics.”

ER not good for dental care

The antibiotics get the swelling to go down, and prescription drugs can help with the pain, but visiting the emergency room for dental care is not a good decision, Hatfield said.

The emergency room does not give any true, long-term relief for dental problems. When the patients leave, they continue to need an extraction or root canal, she said.

“It’s a huge gap in health care services, not just in Lubbock, but it’s a national problem,” Hatfield explained. “So many people don’t have insurance. I really think, from what we see not just in the ER, but with the community outreach (dental program), there’s a huge gap in particularly dental health care. There are several companies that offer health insurance but not dental. The people we’re seeing coming in, it’s not only people who don’t have jobs, a lot of them work. And they’re falling through the cracks in health care because they don’t have access to dental insurance.”

Hatfield said the majority of the dental problems seen at Covenant are caused by not having preventative dental care. As a result, patients need root canals and extractions, which can cost up to $6,000, she said.

“When they get an abscess or have two or three teeth that need to be extracted, it’s not something that happens overnight,” she said. “It’s mostly a lifetime of a lack of access to dental care and a lack of education on dental care. If they had a preventative dental home, and had been with a dentist, seen every six months or a year. It ends up being a costly problem for the patient.”

Covenant refers these patients to its Community Health Outreach Dental Program. The program typically charges a $20 copay, she said, and performs dental cleanings, extractions, root canals and fillings. It also has denture and partial programs.

No dentists at UMC ER

Dr. Joe Sasin, medical director for the University Medical Center emergency center, said patients seek dental care in the UMC emergency room several times a day. UMC also treats pain and infection, he said.

Three dentists work at the hospital, but none come to the emergency department for immediate dental care, he added.

He believes one reason is because Medicaid does not cover dental care, and people don’t have the means to access private dentists. He also said some people may not want to spend their money at the dentist, and they view the emergency room as somewhat “free” care.

Often patients don’t pay their bills, he said.

“The lack of dental availability is only one of the money problems we deal with in medicine as far as access to care,” he said. “A shrinking number of physicians accept Medicaid and Medicare. ... There are multiple areas and holes in the system where we in the (emergency department) end up being the safety net.”

According to a news release from the Pew Center on the States, in 2009, 56 percent of Medicaid-enrolled children did not receive dental care — not even a routine exam.

The access problem is driven by multiple factors, including a shortage of dentists in many areas of the U.S., and the fact that many dentists do not accept Medicaid-enrolled children.

“The fact that so many Americans go to hospitals for dental care shows the delivery system is failing,” said Shelly Gehshan, director of the Pew Children’s Dental Campaign, in the release. “The care provided in an ER is much more expensive, and it generally doesn’t solve dental problems. Most hospital ERs are not staffed with dentists, and the medical personnel who work there are not trained to treat the underlying problems of patients with untreated dental issues.”

Uncompensated medical care

Sasin said UMC is a county-supported facility, but only about 4 to 5 percent of its operating budget is county funding. He said 95 percent of what UMC does is not compensated for by the local government programs for federal and state disproportionate share money.

Sasin said it’s not always a bad idea for people to come to the emergency room with dental pain.

“As a physician who wants to really help people and wants the best for patients, if they have a severe dental pain, or a question or concern, I always want them to see a physician somewhere if they have the ability to,” he said. “At least a physician who’s not a dentist, we don’t have dental training, at least we can point them in right direction. ... It may cost you time in a waiting room, and it will certainly cost you a few hundred dollars at least. You have to weigh the cost against the benefit, and sometimes that’s the only option.”

Need for increasing dental care

Sasin said UMC regularly sees children, mentally challenged people and elderly people come in for dental care. The hospital keeps track of people who have repeated dental visits — many times drug abusers — and when appropriate, restricts their prescribing of narcotic pain medications and resorts to other options.

“The terrible thing is I’ve seen patients with the same cavity on repeat visits that I’ve told them multiple times before, ‘You need to get a dentist. (We’re going to give you) a referral.’ And I remember seeing the same exact tooth in the past,” Sasin said.

Sasin said he would like to see the Lubbock community support increasing dental care. If a group could look at all the sides of dental care ‑ from health care to city government ‑ it could find solutions, he said.

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Why would anyone think there would be a dentist on call for the ER?
That makes no sense. An ER DR can not pull teeth, you have to see a dentist. Yes, I know Dentist only take cash, not insurance, but there are dental clinics that are offered for low income people. You have to be willing to go there.
These are the same people who call an ambulance for a cold when they have people at home who can drive them, but leave just as the ambulance pulls up.

That's what happens when you turn any supposedly funded service over to the city. The funds just go "poof". I called every one of those clinics and they say they have a list that you can sign up for but they won't have any money or any appointments open for at least a year. They run it like MHMR. Take the federal and state monies and give the clients the worst service possible. What a farce....dental clinics for the poor!!!